Gas obturating method

ABSTRACT

A method of diagnosis and/or therapy of an internal part of the body accessible from an adjacent body opening, characterized by the use of an endoscope having a passageway therein which terminates in a tubular distal end insertable into the opening and into close proximity to the desired body part, and including the steps of: placing the tubular distal end of the endoscope at the proximal end of the body opening. While simultaneously introducing a gas under pressure into the passageway in the endoscope at a rate such that the gas entering the body opening ahead of the tubular distal end of the endoscope acts as an obturator facilitating insertion so that the endoscope may be moved longitudinally of the body opening, and performing an indicated diagnostic and/or therapeutic operation on the desired body part through the passageway in the endoscope during and/or after movement of the tubular distal end of the instrument longitudinally of the body opening. The method includes the additional step of visually examining the walls of the body opening through the passageway in the endoscope as the tubular distal end of the instrument is moved longitudinally of the body opening so that the walls of the body opening are examined before the instrument can have any traumatic effect thereon. The tubular distal end of the endoscope comprises a removable barrel suitable for a particular diagnostic and/or therapeutic operation and replaceable by a different barrel suitable for a different diagnostic and/or therapeutic operation. Thus, the endoscope may be used as an anoscope, a proctoscope, a sigmoidoscope, a coloposcope, a hysteroscope, a culdoscope, an amnioscope, a urethroscope, a cystoscope, a laparoscope, and the like. The barrel may carry an inflatable cuff where appropriate to provide a substantially gas tight seal between the barrel and the periphery of the proximal end of the body opening.

United States Patent 1 Robertson [54] GAS OBTURATING METHOD 75] Inventor: jack R. Rdbertsonf same Ynelz,

Calif. 93454 [22] Filed: Oct. 27, 1971 {211' Appl.No.: 193,217

Related US. Application Data [62] Division of Ser. No. 885,248, Dec. 15, 1969, aban- Primary Examiner-Lucie H. Laudenslager Attorney-Harris, Kern, Wallen & Tinsley [57] ABSTRACT A method of diagnosis and/or therapy of an internal part of the body accessible from an adjacent body opening, characterized by the use of an endoscope having a passageway therein which terminates in a tubular distal end insertable into the opening and into l I i 4 45] Jan. 9, 1973 close proximity to the desired body part, and including the steps of: placing the tubular distal end of the entor facilitating insertion so that the endoscope may be I moved longitudinally of the body opening, and performing an indicated diagnostic and/or therapeutic operation on the desired body part through the passageway in the endoscope during and/or after movement of the tubular distal end of the instrument longitudinally of the body opening. The method includes the additional step of visually examining the walls of the body opening through the passageway in the endoscope as the tubular distal end of the instrument is moved longitudinally of the body opening so that the walls of the body opening are examined be fore the instrument can have any traumatic effect thereon. The tubular distal end of the endoscope comprises a removable barrel suitable for a particular diagnostic and/or therapeutic operation and replaceable by a different barrel suitable for a different diagnostic and/or therapeutic operation. Thus, the endoscope may be used as an anoscope, a proctoscope, a sigmoidoscope, a coloposcope, a'hysteroscope, a culdoscope, an amnioscope, a urethroscope, a cystoscope, a laparoscope, and the like. The barrel may carry an inflatable cuff where appropriate to provide a substantially gas tight seal between the barrel and the periphery of the proximal end of the body opening.

5 Claims, 6 Drawing Figures PATENIED JAN 9 I975 INVENTOR JACK R. ROBERTSON BY HIS ATTORNEYS. HA/eR/s, K/ECH, RUSSELL & KER/v.

GAS OBTURATING METHOD CROSS REFERENCE TO RELATED APPLICATION This application is a division of my application Ser. No. 885,248, filed Dec. 15, 1969, and now abandoned.

BACKGROUND OF INVENTION The present invention relates in general to an endoscope and to a method of using same in performing indicated diagnostic and/or therapeutic operations on various internal parts of the body accessible from adjacent body openings. The term endoscope is used generically herein to include various species for use in diagnostic and/or therapeutic operations on corresponding internal parts of the body, examples being amnioscopes, colposcopes, culdoscopes, hysteroscopes, vaginoscopes, urethroscopes, cystoscopes, anoscopes, p'rotoscopes, sigmoidoscopes, and laparoscopes (peritoneoscopes).

In each instance, the instrument of the invention is provided with a passageway therethrough which terminates in a tubular distal end insertable into the proximal end of the appropriate body opening and movable longitudinally thereof into close proximity to the body part to be subjected to diagnosis and/or therapy. This body part may comprise the walls of the body opening itself, the walls of a passage communicating with the opening, the interior of an organ communicating with the opening, the exterior of an organ accessible through the opening, or the like.

SUMMARY AND OBJECTS OF INVENTION With the foregoing as background, the primary object of the present invention is to introduce a gas under pressure into the passageway in the instrument, while moving the tubular distal end of the instrument longitudinally of the desired body opening, at a rate such that the gas entering the body opening ahead of the tubular distal end of the instrument facilitates insertion by dilating the body opening, and any body passage communicating therewithinto which the tubular distal end of the instrument may be inserted. Thus, the gas introduced through the passageway in the instrument acts as a substitute for the usual mechanical obturator, and will be defined herein as constituting an obturator for convenience. Preferably, the gas employed is an inert one, such as carbon dioxide, nitrous oxide, helium, or the like, such gases being absorbed readily by the body after completion of the diagnostic and/or therapeutic procedure.

The employment of a gas as an obturator facilitating insertion has numerous advantages. First, by dilating the body opening ahead of the tubular distal end of the instrument, the gaseous obturator of the present invention greatly facilitates insertion. Secondly, it greatly reduces the risk of injury to the walls of the body opening, or any connecting body passage, as compared to the conventional mechanical obturator. A further and extremely important advantage is that the walls of the body opening, and any connecting body passage, may be examined visually through the passageway in the instrument during insertion of the instrument, something which is impossible with a mechanical obturator. Consequently, the desired examination can be carried out before the instrument can have any traumatic effect on the areas to be observed. This is an important feature of the invention since it assures the physician that any traumatic condition he may see was not caused by the instrument he is using.

Another important feature of the invention is that any body part which requires dilation forproper examination can be dilated by the gas which serves as an obturator, or by additional gas introduced through the passageway in the instrument. For example, in a urethroscope species of the invention, the urethra may be dilated with gas as required for proper examination, instead of using water, as is conventional. The use of a gas as a dilator has the additional and very important advantage of providing a clear visual field, the visibility in a gas field being vastly superior to that in a waterfield. lt is also technically impossible to dilate the distal urethra with water.

Yet another advantage of the gaseous obturating procedure of the invention is that the gas used as an obturator, or additional gas introduced through the passageway in the instrument, may be used to inflate a body cavity or organ to be subjected to diagnosis and/or therapy. This combination gaseous obturating and inflating technique may be used inconjunction with a laparoscope of the invention to inflate. the abdominal cavity to facilitate an indicated diagnostic and/or therapeutic procedure on an organ therein, or it may be used in conjunction with other species of the generic endoscope of the invention to inflate corresponding organs susceptible to this technique.

It might be well to point out at this juncture that the use of a gas under pressure as an obturator is applicable to most endoscope species of the invention. The colposcope is an exception since it involves only simple vaginal insertion requiring no obturation.

In accordance with the invention, any indicated diagnostic and/or therapeutic procedure may be carried out through the same passageway in the instrument. which serves to introduce the obturating, dilating and/or inflating gas. The proximal end of the passageway in the instrument may be equipped with suitable optical viewing means, which is preferably removable so that different magnifications may be used as required. Also, photographic means may be substituted if desired in the event that a photographic record of the condition of a particular body part is desired. Also, any suitable diagnostic technique, other than visual or photographic examination, and any suitable therapeutic technique, maybe carried out through the passageway in the instrument, at the same time carrying out visual observations through the same passageway. This may be accomplished by inserting the desired diagnostic and/or therapeutic device through the optical viewing means. Thus, the physician can obtain urine samples, perform biopsies, carry out cauterization procedures, and the like, while visually observing such procedures.

-Another object of the invention is to provide a substantially gas tight seal between the tubular distal end of the instrument and the periphery of the body open- Still another and important object of the invention is to provide an instrument which may be converted from one endoscope species to another simply by interchanging barrels each capable of forming the tubular distal end of the instrument. More particularly, an object of the invention is to provide an. endoscope the tubular distal end of which comprises a removable barrel suitable for'a particular diagnostic and/or therapeutic operation and replaceable by a different barrel suitable for a different diagnostic and/or therapeutic procedure. With this construction, the same basic instrument may be used for a wide variety of purposes simply by selecting the appropriate barrel, optics, and diagnostic and/or therapeutic accessories.

The foregoing objects, advantages, features and results of the present invention, together with various other objects, advantages, features and results thereof which will be evident to those skilled in the endoscopic art in the light of this disclosure, may be achieved with the exemplary em bodiments of the invention illustrated in the accompanying drawing and described in detail hereinafter. I

DESCRIPTION OF DRAWING In the drawing:

FIG. 1 is a view, partially in side elevation and partially'in longitudinal section, of one endoscope species of the invention, which species is suitable for use as a male -or female urethroscope or cystoscope, a hysteroscope, or a vaginoscope;

FIG. 2 is a view, partially in side elevation and partially in longitudinal section, of a cuff-equipped barrel which may be substituted for the barrel of FIG. I to convert the instrument of the invention into a culdoscope or laparoscope;

FIG. 3 is a transverse sectional view taken as indicated by the arrowed line 3-3 of FIG. 2;

FIG. 4 is an enlarged transverse sectional view taken as indicated by the arrowed line 4--4 of FIG. 2;

FIG. 5 is an enlarged, fragmentary sectional view taken as indicated by the arrowed line 5-5 of FIG. 2; and

FIG. 6 is a semidiagrammatic sectional view illustrating the culdoscopic species of the invention in use.

DESCRIPTION OF EXEMPLARY EMBODIMENTS OF INVENTION gas under pressure, reference being made to the copending applications for more detailed disclosures.

The lighting system in the housing 12 may be supplied with light-through an optical fiber cable 18, and gas may be supplied from the source in the handle 14 under the control of a normally open valve 20 on the handle.

The instrument is provided with a passageway 22 which extends through the housing 12 and the barrel 16. Light fromthe lighting system in the housing 12 is projected through the passageway 22 to the distal end thereof, and gas under pressure is introduced into the passageway, under the control of the valve 20, through a passage 24. The housing 12 carries a removable optical viewing means 26 in communication with the proximal end of the passageway 22. Preferably, the viewing means 26 is th'readedly connected to the housing 12 in alignment with the passageway 22. If a different magnification is desired, the viewing means 26 may be removed and another substituted. Alternatively, a photographic means, not shown, may be substituted if a photographic record is desired. The particularoptical viewing means 26 illustrated is equipped with means 28 providing a passage therethrough for any desired diagnostic and/or therapeutic device, not shown, such as a urine sampler, a cauterizing implement, an'instrument for performing a biopsy, or the like. The particular procedure being carried out may simultaneously be observed through the viewing means 26.

v The barrel 16, which may be formed of metal, plastic, or any suitable material, is of a size to permit ready insertion into the male or female urethra and through it into the bladder. In the particular construction illustrated, the barrel 16 is provided adjacent its proximal end with a vent 30 equipped with a valve 32 which may be opened to release air or gas from the urethra or bladder if desired.

Considering the operation of the urethroscope or cystoscope 10, the distal end of the barrel 16 is inserted into the proximal end of the urethra 34 and gas under pressure is introduced into the passageway 22 under the control of the valve 20. This gas enters the urethra 34 ahead of the tubular distal end of the instrument l0 and tends to dilate urethra ahead of the distal end of the barrel 16, as indicated at 36. Thus, the gas acts as an obturator facilitating insertion of the barrel 16 into .the urethra and, if desired, through the urethra into the bladder, which can be inflated by the gas to the extent necessary to permit a complete examination of the interior thereof. As previously pointed out, the walls of the urethra may be examined with this technique as the barrel 16 is being inserted, thereby assuring the physi-:'

cian that any traumatic condition he may observe through the optical viewing means 26 pre-existed, and was not caused by the instrument 10. The physician is able to view the interior of the urethra and, if desired, the interior of the bladder, in a gas field, which provides much greater clarity than the conventional water field. Furthermore, the urethrovesical junction functions normally in a gas field and its function can be observed, which is not true of a water field. The use of a gas has other advantages in the field of urology also. For example, urine samples may be obtained from the ureters as urine spurts therefrom. When a water field is used, this technique cannot be employed, it being necessary to use a ureteral catheter, with the attendant risk of trauma to the interior of the ureter. In operative surgery, structures may be viewed through the endoscope, prior to placing sutures and following the placing of sutures, to determine whether the procedure has been accomplished as in the tightening of the urethrovesical junction in the treatment of stress incontinence. Furthermore, with a gas field, topical solutions may be applied to indicated areas as required, something which is totally impossible with a water field.

Additionally, smears or scrapings of tissue for analysis for possible malignancy can be accomplished in a gas medium, but not in a water field. These and various other advantages of gas obturation, dilation and inflation are applicable not only to the instrument 10, but to various other species of the endoscope of the invention.

Turning now to FIGS. 2 to 6 of the drawing, the invention is illustrated therein as embodied in a culdoscope or. laparoscope 50. FIG. 6 specifically shows the instrument 50 in use as a culdoscope, and it will be referred to hereinafter as a culdoscope for convemence.

The culdoscope 50 includes a barrel 52 of appropriate dimensions which may be threadedly, or otherwise, connected to the housing 12 as a substitute for the barrel 16. The barrel 52 is provided adjacent its proximal end with a gate valve 54 pivotable between open and closed positions through a complementary, generally chordal slot 56 in the barrel. When the gate valve 54 is in its open position, an elastomeric valve 58 suitably secured to the barrel 52 closes automatically to prevent the escape of gas from the interior of the barrel. As shown in FIG. 5, the elastomeric valve 58 is provided with a generally chordal slit 60. having overlapping edges 62 which automatically seal against the escape of internal pressure when the gate valve 54 is pivoted open. When it is desired to close the gate valve 54, it passes between the overlapping edges 62 of the slit 60 into the barrel 52.

The gate valve 54 is normally open, and is closed only when it is desired to substitute one optical viewing means 26 for another, or a photographic means for the optical viewing means, after the barrel 52 has been inserted through a small opening at the top of the vagina into the cul-de-sac, as shown in FIG. 6 of the drawing. Thus, an optical or photographic substitution may be made without loss of gas previously introduced into the peritoneal cavity to inflate same to facilitate diagnostic and/or therapeutic procedures.

The culdoscope barrel 52 is also provided with an inflatable' annular cuff or cuff means 64 which, as shown in FIG. 6, may be inflated through an elastomeric tube 66, after insertion of the distal end of the barrel 52 into the cul-de-sac,'to prevent the escape of gas from the peritoneal cavity around the exterior of the barrel 52. As will be clear from FIG. 6, the cuff 64 engages the walls of the vagina in a-substantially gas tight manner to prevent, or at least minimize, loss of gas from the peritoneal cavity.

In the particular construction illustrated, the cuff 64, which is preferably made of an elastomeric material, includes an inner tube 68 carrying an inflatable annular chamber 70 with which the inflation tube 66 communicates. The inner tube 68 fits the barrel 52 snugly to hold the cuff 64 in place during insertion. Subsequent inflation of the annular chamber 70 urges the outer periphery thereof firmly against the vaginal walls, and further, urges the inner tube 68 firmly against the exterior of the barrel 52.

The culdoscope version 50 of the endoscope of the invention may be used in a similar fashion to the instrument 10, and has similar advantages. Consequently, a more detailed description is not necessary to a complete disclosure of the invention.

lt will be understood that although the foregoing disclosure has been limited to a barrel 16 for a female urethroscope or cystoscope and to a barrel 52 fora culdoscope or hysteroscope, other barrels may be substituted to obtain other species of the basic endoscope of the invention. For example, the endoscope may be converted to an anoscope, proctoscope, sigmoidoscope, amnioscope, male urethroscope or cystoscope, laparoscope, or the like, by substituting an appropriate barrel. Also, telescopes permitting viewing at an angle, or even retrograde viewing, may be substituted. The endoscope of the invention may be used as a colposcope without a barrel.

The previous disclosure has suggested a number of diagnostic and/or therapeutic procedures which can be carried out by way of the passageway 22 through the instrument, and which can be observed visually at the same time. Numerous other diagnostic and/or therapeutic procedures may be carried out with the various versions of the basic endoscope. For example,

utilizing the instrument 10 as a hysteroscope, the physician may carry out and simultaneously observe, through the barrel 16, such procedures as taking of biopsies, suction or aspiration of uterine contents, dila tion of the uterus and curettage, removal of polyps, opening of Fallopian tubes by means of the gas used to dilate the uterus, cryosurgery, cautery or fulgaration, insertion of intrauterine devices, determining whether intrauterine devices are still in place, and the like. In each of these techniques, the ability to introduce a gas into the uterus through the barrel 16 to dilate the uterus is of paramount importance since the dilating gas field permits a clear view of the interior of the uterus in each instance.

Somewhat analogous diagnostic and/or therapeutic techniques may be carried out in conjunction with each of the other species of the generic endoscope of the invention. Consequently, further explanations herein are not necessary.

' Various materials may be used for the various parts of the different species of the endoscope of the invention. Any parts which contact or can contaminate the bodies of the patientsmust, of course, be sterile, and

this may be accomplished by making such parts of sterilizable materials, or of aseptic disposable materials.

Although exemplary embodimentsof the invention have been disclosed for purposes of illustration, itfwill be understood that various changes, modifications and substitutions may be incorporated in such embodiments, and that the invention may be incorporated in numerous other embodiments, all without departing from the spirit of the invention as defined by the following claims.

I claim as my invention:

1. A method of diagnosis and/or therapy of an internal part of the body accessible from an adjacent body opening, characterized by the use of an instrument having a passageway therein which terminates in a tubular Y distal end insertable into the opening and into close body part, and including the introducing a gas under pressure into the passageway in theinstrument, while moving the tubular distal end of the instrument longitudinally of the body opening, at a rate such that the gas entering the body opening ahead of the tubular distal end of the instrument acts as an obturator facilitating insertion; and performing an indicated procedure on the desired body part through the passageway in the instrument with the tubular distal end of the instrument inserted into the body opening.

2. A method as set forth in claim .1 including the step of visually examining the walls of the body opening through the passageway in the instrument as the tubular distal end of the instrument is moved longitudinally of the body opening so that the walls of the body openi of viewing the interior of the body opening and/or a body cavity with which it communicates through the passageway in the instrument while introducing a gas into the passageway.

5. A method according to claim 1 including the step of providing a substantially gas tight seal between the periphery of the body opening and the tubular distal end of the instrument. i 

1. A method of diagnosis and/or therapy of an internal part of the body accessible from an adjacent body opening, characterized by the use of an instrument having a passageway therein which terminates in a tubular distal end insertable into the opening and into close proximity to the desired body part, and including the steps of: a. placing the tubular distal end of the instrument at the proximal end of the body opening; b. introducing a gas under pressure into the passageway in the instrument, while moving the tubular distal end of the instrument longitudinally of the body opening, at a rate such that the gas entering the body opening ahead of the tubular distal end of the instrument acts as an obturator facilitating insertion; and c. performing an indicated procedure on the desired body part through the passageway in the instrument with the tubular distal end of the instrument inserted into the body opening.
 2. A method as set forth in claim 1 including the step of visually examining the walls of the body opening through the passageway in the instrument as the tubular distal end of the instrument is moved longitudinally of the body opening so that the walls of the body opening are examined before the instrument can have any traumatic effect thereon.
 3. A method according to claim 1 including the step of inflating a body cavity with which said body opening communicates by introducing gas thereinto through the passageway in the instrument.
 4. A method as defined in claim 1 including the step of viewing the interior of the body opening and/or a body cavity with which it communicates through the passageway in the instrument while introducing a gas into the passageway.
 5. A method according to claim 1 including the step of providing a substantially gas tight seal between the periphery of the body opening and the tubular distal end of the instrument. 